Provider Demographics
NPI:1184180309
Name:ARNOLD, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MONTANA AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1141
Mailing Address - Country:US
Mailing Address - Phone:209-470-6941
Mailing Address - Fax:
Practice Address - Street 1:219 MONTANA AVE APT 101
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1141
Practice Address - Country:US
Practice Address - Phone:209-470-6941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2024-07-23
Deactivation Date:2020-09-11
Deactivation Code:
Reactivation Date:2020-09-23
Provider Licenses
StateLicense IDTaxonomies
CA16082101YP2500X
CA148147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional